Enhancing Safety for Patients With

Limited English Proficiency

Overview/Objectives

Understand the safety risk to patients with limited English proficiency

Know the process to assemble the most appropriate and effective care team

Identify and raise patient communication issues

The Story of Willie Ramirez

Results of not having an appropriate interpreter: Misunderstanding of “intoxicado” Inaccurate medical history Cultural deference to authority Quadriplegic teen $71 million lawsuit

High-Risk Settings and Situations

ED OB/GYN Surgery Transitions in care, including intake and discharge Medication reconciliation

Added Risk for LEP Patients

Not using a professional interpreter Using family members or housekeeping staff as

interpreters “Getting by” with provider’s or patient’s poor

language skills

Interpreter only present for part of the encounter

LEP Patients in Your Clinical Area

Percentage of patients LEP Common languages spoken Less common languages Specific issues or problems

Close Call: An Interpreter’s Story

Patient spoke some English…

Interpreter not called Inaccurate medical history Latex allergy almost missed before surgery

“Opportunity” Scenario

What are the risks in this scenario? What was done badly? What key information was missed? What could be done differently?

Benefits of Including Interpreter on the Care Team

Receive more complete and accurate information Facilitate better clinical decisions Receive support from a cultural broker who is

also an advocate for the patient

Implementation

Assertion, Advocacy, andConflict Resolution

Scenario: Mrs. Gilbert, a Haitian immigrant, is in the ED in triage. The front desk staff called the Creole interpreter, Ms. Pierre-Louis. Dr. Malbec is interviewing Mrs. Gilbert in French, but she does not understand his French. Ms. Pierre-Louis knows that Mrs. Gilbert does not understand, but when she attempts to interpret, Dr. Malbec says, “You are not needed. I’ve got it.”

Advocate for the patient Stop all activity if needed Speak up on behalf of the patient

Assert a corrective action in a firm and respectful manner Assertion is not aggression

Advocacy and Assertion

Stop the Line: CUS

When Initial Assertion Is Ignored…

Voice your concern at least two times…it’s your responsibility

If you are being challenged, acknowledge the concern Correct the problem Teach

If the outcome is still not acceptable Take a stronger course of action Use supervisor or chain of command

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Briefs

Planning Form the team Designate team roles

and responsibilities Establish climate

(psychological safety) and goals

Engage team in short-and long-term planning

Psychological Safety Proactively invite input Be accessible Ask for mutual support Remember: Team leader sets tone for the team, while

interpreter creates safety for the patient Leader: “Feel free to stop us at any time if anything is not

clear, or if there is anything I should know about the patient's culture, beliefs, or concerns”

Interpreter: “If anything we say is not clear, please let me know ”

Practice (Optional Exercise)

Scenario: Discharge from the hospital following myocardial infarction

3 characters: a nurse, an interpreter, and a patient

Check-Back Is…

Teach-Back Is…

Confirmation of understanding Opportunity to correct miscommunication Comprehensive

“Tell me in your own words how you will take this medicine when you get home…”

Putting It All Together

“Success” video

Summary

TOOLS and STRATEGIES to Enhance the Safety of Patients With Limited English Proficiency:

Process for including in-person and phone interpreters Brief/ psychological safety Advocacy and assertion CUS Check-back Teach-back